Indwelling pleural catheters (IPCs) have become an essential tool in the management of recurrent pleural effusions. This chapter reviews the evolution and rationale for IPC use, highlighting their role as a definitive, minimally invasive therapy that bridges procedural efficacy with patient-centered outcomes. This chapter addresses optimal patient selection, procedural planning, imaging guidance, and postplacement management. The chapter also reviews catheter complications including troubleshooting and management of adverse outcomes such as infection, catheter tract metastasis, loculated effusions, and drainage failure. By synthesizing evidence-based data and procedural best practices, this chapter provides a comprehensive guide to incorporating IPCs into advanced pleural disease management.